CommercialCoverageMedium impact
Medical Policy Update for December 5, 2023
Blue Cross NC·NC · Family Medicine, Internal Medicine, OB-GYN +3 more·Medical Policy
Effective date
Dec 5, 2023
We identified it
Jun 16, 2026
Summary
Blue Cross NC updated multiple medical policies effective December 5, 2023, with significant changes to genetic testing coverage, laboratory testing criteria, and billing codes. Key changes include expanded BRCA genetic testing beyond just BRCA 1/2 genes, new coverage criteria for celiac disease monitoring, updated cervical cancer screening guidelines, and removal of coverage for routine cervical screening under age 21.
Action Required
Immediately: Billing team must update system with new CPT codes for genetic testing (81432, 81433, 81479, 0102U, 0103U, 0129U) and laboratory tests (0393U, 83880, 88172, 88173, 88177, 81403, 87563). Update encounter forms to reflect expanded BRCA testing coverage beyond just BRCA 1/2 genes. Remove billing for cervical cancer screening for patients under 21 unless specific high-risk criteria are met. Update celiac disease testing protocols to include new monitoring intervals for IgA sufficient/deficient patients.